AccountId: 011433970860
ContactId: 2390a9b5-0d36-479f-b42a-3521169021c4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 288559 ms
Total Talk Time (AGENT): 144591 ms
Total Talk Time (CUSTOMER): 127281 ms
Interruptions: 2
Overall Sentiment: AGENT=1.4, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/08/2390a9b5-0d36-479f-b42a-3521169021c4_20250108T20:12_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] I can
[CUSTOMER][NEUTRAL] Hello, this is [PII] with Doctor [PII] and Doctor [PII]'s office, and I would just need to get benefits on a patient.
[AGENT][POSITIVE] OK, yeah, I'd love to help you with that today, Ms. [PII], and hang tight with me one second while I get my system pulled back up. I'm sorry.
[CUSTOMER][POSITIVE] OK, no problem.
[AGENT][NEUTRAL] All right, and do you mind if I grab a good call back number from you real quick?
[CUSTOMER][NEUTRAL] Yeah, that's [PII].
[AGENT][POSITIVE] Perfect and you said you were looking for eligibility was that correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] Perfect. And your member's policy number?
[CUSTOMER][NEUTRAL] That is 02556944.
[AGENT][POSITIVE] Wonderful. Thank you so much.
[CUSTOMER][NEUTRAL] Um-hum.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] All right. Would you be able to also go ahead and verify for me your patients first I cannot talk today. I'm so sorry. The first and last name and date of birth, yes, it has.
[CUSTOMER][NEUTRAL] That's OK. It's been a long day. It's uh [PII].
[AGENT][NEUTRAL] Perfect, and her date of birth?
[CUSTOMER][NEUTRAL] And it's [PII] oh sorry uh [PII].
[AGENT][POSITIVE] Thank you so much. I really appreciate that. And it looks like your patient is current and active. Her effective date is
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] December, no, I am so sorry. It's not working today. um [PII].
[CUSTOMER][NEUTRAL] Mhm that's OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alrighty.
[AGENT][NEUTRAL] And then are you needing any other information as far as the eligibility is concerned?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So we're um a dermatologist so I just needed to get benefits for an office setting with a specialist and then also to see if she has benefits for an ambulatory surgery center.
[AGENT][NEUTRAL] All right, perfect. Um, I, let me get those benefits loaded. I do want to let you know that any benefit information to give you over the phone is just a verification of coverage and not a guarantee of payment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, all right, as far as
[AGENT][NEUTRAL] This, um, she does have outpatient benefits in a physician's office for accidents and sickness.
[AGENT][NEUTRAL] Um, and with that, it is.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] $50 she can use up to 4 visits a year.
[CUSTOMER][NEUTRAL] 50 for 4.
[AGENT][NEUTRAL] And then
[CUSTOMER][NEUTRAL] The
[AGENT][NEUTRAL] You said an outpatient surgery center?
[CUSTOMER][POSITIVE] Correct, mhm.
[AGENT][NEUTRAL] All right, she does have an accident and sickness surgical benefit. Um, if it, it's done in a facility, she can have up to $250 once per calendar year, and if it's done in a physician's office, it's $125 up to twice the calendar year.
[CUSTOMER][NEUTRAL] 150 you said?
[AGENT][NEUTRAL] 125 in an office and then 250 in a facility.
[CUSTOMER][NEUTRAL] For the office, oh sorry, 125.
[CUSTOMER][NEUTRAL] So basically um now.
[CUSTOMER][NEUTRAL] Would she get any other discounts like when it's billed, do they get like contracted rates or anything?
[AGENT][NEUTRAL] We're just a limited limited hospital indemnity policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So
[CUSTOMER][NEUTRAL] So if she were to be coming in for a removal of the lipoma, um, I guess it's not really considered an accident or sickness, so I guess would it even apply to that?
[AGENT][NEUTRAL] I'm not sure. I wouldn't be able to, I mean, I wouldn't be able to know unless like I have the claim form in hand.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, so basically $50 she gets paid up to 4 visits a year and then for anything done surgery center $250 it can pay towards that once a year and then if it's an office setting with a physician up to 2 times for 125.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Yes, absolutely.
[CUSTOMER][NEUTRAL] OK, and then um for the payer ID for claims.
[CUSTOMER][NEUTRAL] They have um 64556.
[AGENT][NEUTRAL] And let me double check that one for you.
[AGENT][NEUTRAL] 645-556, yes.
[CUSTOMER][NEUTRAL] OK, alrighty, I guess that's all I need. Do we have a reference number?
[AGENT][NEUTRAL] Yes, it's gonna be my name [PII] I'm sorry.
[CUSTOMER][POSITIVE] Mhm, OK, you're good.
[AGENT][NEUTRAL] Um, it's my name in today's date.
[CUSTOMER][POSITIVE] Alrighty thank you very much.
[AGENT][POSITIVE] Hey, it's my pleasure, Ms. [PII]. Thank you so much for calling APL and I hope you have a fabulous afternoon.
[CUSTOMER][NEUTRAL] Uh huh
[CUSTOMER][POSITIVE] Alright you too thank you.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Alright bye bye.